Disfunciones sexuales

Well, this post is dedicated to my friend Ferry. Happy birthday !!!!!

It's not like you need it, go, I don't know if it serves you, better! But I thought you were already tired of seeing cuties in balls and searched for a book!!

Sexual Dysfunctions

Author:Janoi Gonzales


Course PresentationSexual dysfunctions are the different forms of inability to participate in a desired sexual relationship. It is a lack of interest, an impossibility of feeling pleasure, a failure in the necessary physiological response for an affective sexual interaction or an inability to control and feel orgasm. Know with this course the causes that can cause sexual dysfunction, whether physical or psychological, and how to combat them. 1.Sexual Dysfunctions. IntroductionSexual functioning in men and women depends on the set mental previous (or sexual motivation state) or desire state, effective vasodilative excitement (erection in man, lubrication in woman) and orgasm. The orgasm in man includes emission and ejaculation. Emission produces a sense of inevitable ejaculation, mediated by prostate, seminal vesicle, and urethral contractions. The orgasm in woman is accompanied by contractions, not always subjectively experienced as such, of the muscles that comprise the outer third wall of the vagina. In both sexes, generally, there is observed generalized muscular tension, perineal contractions, and involuntary pelvic impulses. Orgasm is followed by resolution, a general sense of relaxation, well-being, and muscle relaxation. During this phase, men become physiologically refractory to subsequent erections and orgasms for a certain period of time. Women can respond to additional stimulation almost immediately. The sexual response cycle is mediated by delicate interrelations (or balanced) between the sympathetic and parasympathetic nervous systems. Vasodilation is largely mediated by parasymptomatic flow, while orgasm is predominantly sympathetic. Ejaculation is almost completely sympathetic, while emission involves a more balanced combination of sympathetic and parasympathetic stimuli. All these reflex responses are easily inhibited by cortical influences or neural, hormonal, or vascular mechanisms impaired. Alpha and beta-adrenergic blockers can desynchronize emission, ejaculation, and perineal muscle contractions occurring during orgasm. Sexual dysfunctions are different forms of inability to respond to a stimulus. Participate in a desired sexual relationship, it is a lack of interest, an impossibility to feel pleasure, a failure in the physiological response necessary for an affective sexual interaction or an inability to control and feel orgasm. 2.EtiopathogenesisThe sexual response is a psycho-physiological process, therefore:

1. Psychological factors:
§ Hostility towards the partner;
§ Fear of the partner's genitals or intimate relationship or loss of control, or
fear of dependence due to pregnancy; § Guilt after a pleasurable experience; § Depression and anxiety created by marriage, stressful situations,
aging, ignorance of sexual conduct norms (frequency and duration of coitus, orogenital sex, or sexual practices) or sexual myths;
§ Immediate causes of anxiety: fear of failure, desire for realization, expectation
(observation of one's own physical responses), excessive desire to please the partner, and avoidance of sex and talking about sexual concerns, other inhibitory factors include ignorance (often as a consequence of an inhibited learning process based on anxiety, shame, and guilt), or lack of knowledge about sexual organs and their function, traumatic events from childhood and adolescence (incest or violation), feeling of inability, religious upbringing, excessive modesty, and puritanical aversion to coitus.
§ Interpersonal and situational causes (marital discord and relationship boredom).

2. Organic factors:
a) Male causes:
§ Inadequate environment;
§ Indifferent attitude from the partner; § Fear of diseases; § Feminine-dominant education; § Underlying latent homosexuality; § Marital disagreements; § Anticipatory anxiety; § Symbolization of erection.

b) Female causes:
§ Inadequate environment; § The man's inability to satisfy her; § Fear of diseases; § Masculine-dominant education; § Underlying latent homosexuality; § Fear of pregnancies; § Traumatic sexual events.Sexual Dysfunctions. Classification1. Absence or loss of sexual desire (inhibited or hypoactive sexual desire);
2. Sexual rejection and absence of sexual pleasure:
a) Sexual aversion;
b) Absence of sexual pleasure.
3. Failure of genital response;
4. Orgasmic dysfunction;
5. Premature ejaculation;
6. Non-organic vaginism;
7. Non-organic dyspareunia;
8. Excessive sexual impulse.
Another classification is given by the frequency in one or both sexes:
In men:
§ Sexual excitement disorder (erectile dysfunction or impotence);
§ Orgasm disorder (premature ejaculation);
§ Inhibited orgasm (delayed ejaculation);
§ Sexual anhedonia.
II.
In women:
§ Sexual excitement disorder;
§ Inhibited orgasm;
§ Dyspareunia;
§ Vaginism.
Loss of Sexual Desire
This disorder is defined by the DSM III as persistent and universal inhibition of sexual desire in both men and women.
Sexual desire is a psycho-physiological process based on cerebral activity and cognitive scripting, including aspiration and sexual motivation. The desynchronization of these components results in inhibited sexual desire.
To make a diagnosis, it is necessary that the loss of sexual desire be the main problem and not secondary to other sexual difficulties such as erectile failure or dyspareunia. The absence of sexual desire does not exclude pleasure or excitement, but makes it less likely for the individual to engage in any sexual activity in this sense.
The most frequent causes are relationship boredom, depressions, psychoactive medications, anti-hypertensive medication, hormonal deficits and can be secondary to insufficient sexual function alteration, childhood or adolescent trauma, and insufficient androgen levels.
Includes: - frigidity;
- Hipoactive sexual desire disorder. administration of testosterone in patients with insufficiency.

Excessive Sexual Impulse
Both men and women can occasionally complain about excessive sexual impulse as a problem in itself, usually at the end of adolescence or at the beginning of adulthood, when excessive sexual impulse is secondary to an affective disorder or when it appears in the initial stages of dementia, must be coded here.
Includes: - nymphomania;
- satyriasis.

Sexual Rejection
It is characterized by intense negative feelings accompanying the prospect of sexual interaction with a partner, and produces sufficient anxiety and fear to avoid sexual activity.

Absence of Sexual Pleasure
Normal sexual responses occur and orgasm takes place, but there is an absence of corresponding pleasure. This complaint is much more frequent in women than in men.
Includes: anhedonia (sexual).

PS.: The general disorder of sexual rejection and absence of pleasure is known as sexual aversion disorder in other literatures.

Causes can be lifelong such as social trauma, incest, sexual abuse, rape, repressive family environments, rigid and orthodox religious education, mild or severe dyspareunia produced in the first attempts, and causes can be secondary to problems in the couple's relationship such as trauma or dyspareunia.
PS.: If aversion produces a phobic response, panic may occur.

Treatment:
§ Eliminate the underlying cause;
§ Paicotherapy conductual or paicodinamic or conjugal therapy;
§ If panic disorders appear, tricyclic antidepressants can be administered.

Failure of Genital Response (Sexual Excitation Disorder)
In men, the fundamental problem is dysfunction for erection (or impotence), for example, a difficulty in achieving or maintaining an adequate erection for satisfactory penetration.
The causes of Primary erectile dysfunction is rare and usually caused by intrapsychic factors such as abnormal fear of the vagina, sexual guilt, intimacy fear or depression. Secondary causes account for around 70%, which are mostly psychological. The dysfunction can be situational due to factors like location, time, specific partner, competitive defeat or self-esteem damage. Physical factors include systemic diseases like diabetes (the most common), syphilis, alcoholism, drug dependence, hypopituitarism and hypothyroidism, local alterations such as inflammation or congenital genital alteration, vascular and neurogenic alterations, and the use of drugs like anti-hypertensives, amphetamines and sedatives. Treatment options include: education; myth elimination; patient relaxation; Master and Johnson technique (genital pleasure attainment and demanding intercourse, three-stage focal sensitivity process); if unsuccessful after six sessions, send to a sexual therapist; testosterone administration for low androgen levels (<300mg/dl); psychotherapy; if not responding to psychotherapy and organic dysfunction, inject papaverine and fentolamine; penile implant. In women, the fundamental problem is vaginal dryness or lubrication failure, which can be psychogenic, pathological or due to estrogen deficiency. It is rare for women to primarily complain of vaginal dryness, except as a symptom of postmenopausal estrogen deficiency. Most cases are caused by acquired psychological factors such as inadequate sexual stimulation by the partner (male), marital disconnection (in 80% of cases), depression, stressful situations, ignorance of clitoral anatomy and function. patterns and effective techniques of excitement. There may be an association between sex and sin, between sex and guilt, or fear of intimacy. Physical or organic factors are localized diseases (endometriosis, cistitis, vaginitis), systemic diseases (hypothyroidism, DM), neurological and muscular alterations, drugs, and ablative surgery (hysterectomy). Concerning aging, despite women being able to experience orgasms throughout their lives, sexual activity generally decreases after 60 years. The diagnosis of this disorder is made by the antecedents and physical examination.Organic DysfunctionWhen this disorder presents itself, the orgasm does not occur or is excessively delayed. The disorder can appear in specific situations (for example, only on certain occasions or circumstances, in which case the etiology is probably psychogenic) or permanently, in which case it is difficult to rule out somatic or constitutional factors, except if there is a satisfactory response to psychological treatment. Orgasmic dysfunction appears in both sexes, but is more frequent in women.

In men, it is called inhibited orgasm or delayed ejaculation, a relatively rare phenomenon in which there is no intravaginal ejaculation or, less frequently, an inability to achieve ejaculation through masturbation.

Generally, the etiology is psychogenic, but organic factors such as DM, the use of thioridazide, mesoridazide, and antihypertensives can impede ejaculation. Neurological factors such as multiple sclerosis also appear.

To : § The patient should stimulate until ejaculation outside the vagina, then at the level of the labia of the vagina, and finally inside it, if this technique fails, psychotherapy is recommended.

In women, it is called inhibited orgasm, which is the inhibition of orgasm after normal sexual excitement during adequate sexual activity in terms of place, intensity, and duration. It can be primary, secondary, or situational. About 10% of women do not reach orgasm with any source of stimulation or in any situation. Most women can have an orgasm through clitoral stimulation, but more than 50% of women are unable to achieve regular orgasms during intercourse.

To : § Eliminate the causes, whether primary, secondary, or situational; § Sensitization exercises in three stages of Master and Johnson, which involve the couple in steps. that encompass non-genital pleasure, genital pleasure and non-demanding coitus. § Individual or group psychotherapy; § Knowledge of the female sexual organs as to their function and anatomy; § Increase in vaginal sensitivity with exercises of contraction of the pubococcigeal muscle, at the level of the external third of the vagina, these are Kegel exercises by contracting 10-15 times three times a day for approximately three months. This disorder includes psychogenic anorgasmia and orgasmic inhibition.Premature EjaculationIt is a constant failure to maintain penetration for sufficient time to satisfy the couple. It can also be defined as ejaculation that occurs before the individual's will. This disorder consists of the inability to control the appearance of ejaculation during the necessary time for both participants to enjoy sexual intercourse. In some severe cases, ejaculation may present itself before penetration or absence of erection. Premature ejaculation is rare due to organic causes but may present as a psychological reaction to an organic dysfunction, for example, failure of erection or presence of pain. Premature ejaculation is also considered premature if the erection requires prolonged stimulation, so that the time interval from sufficient erection to ejaculation shortens. In such cases, the primary problem is a delay in erection.

• Reduce sexual tension;
• Sometimes an explanation about the mechanism of premature ejaculation, reestablishing confidence and simple advice are curative;
• The technique of pause-start, which involves stimulating the penis, whether manual or during coitus, until the patient indicates they are about to ejaculate, then stop stimulating and resume after 20-30 seconds, the couple repeats this technique initially with manual stimulation and later during coitus, stopping three to four times before allowing ejaculation, with this technique controlling ejaculation for 5-10 minutes or more;
• Individual or conjugal psychotherapy.Non-organic vaginism and non-organic dyspareuniaVaginismo not Organic
It is a muscular spasm conditioned by the pelvic wall that surrounds the vagina, which causes vaginal opening obstruction. In this case, penile entry is impossible or very painful. Vaginism can be a secondary reaction to some local cause of pain, in which case it should not be categorized.

It has primary and secondary causes, such as dispareunia, fear of pregnancy, being controlled by the man, losing control, or being damaged during coitus, etc.

The diagnosis is made by rejecting medical exploration, clinical history, and physical examination.

Treatment:
• Gradual dilation technique, where rubber or crystal dilators of different sizes are introduced into the vagina and left for at least 10 minutes;
• Kegel exercises can be used while a dilator is inserted;
• Placing one's hand on the inner thigh with contraction and relaxation of the same helps dilation;
• Also introducing fingers by the patient twice a week.

Non-Organic Dispareunia
Non-organic dispareunia (pain during penetration) occurs in both women and men. It can often be attributed to local pathology, in which case it should be coded according to the corresponding disorder. In some cases, there is no organic cause and psychogenic factors may be important. This category should only be used if there is no other sexual dysfunction (for example, vaginism, vaginal dryness).

This disorder includes psychogenic dispareunia.

Treatment:
• Temporary avoidance of coitus;
• Seat baths;
• Use of lubricants during coitus;
• Sexual education talk to give knowledge of the function and anatomy of the genitals of the partner.

Sexual Anhedonia in Men
Rarely a patient feels that he cannot achieve neither erection nor ejaculation without feeling any pleasure during the Orgasm. The cause is a psychogenic penile anesthesia in a hysteric or obsessive patient. It is indicated to consult Psychiatry, unless there exists a spinal cord lesion or peripheral neuropathy. The loss of tactile sensation in the penis is probably not neurogenic, unless there are also anesthetic areas around the anus or scrotum.

Bibliography

§ CIE-10; pp 236-241.
§ Merck Manual of Medicine; 15th edition 1987; pp 1827-1836.
§ Various Authors; Madrid-Spain; pp 1751-1760.http://rapidshare.com/files/403113300/Disfunciones_sexuales.pdf.html" rel="nofollow" target="_blank">http://rapidshare.com/files/403113300/Disfunciones_sexuales.pdf.html